In 2012 I was privileged to present at the Mind and its Potential Conference. Below is the video of my presentation. It has been on our Facebook page for a while and got shared around the viral world with really good feedback for which I am grateful. I thought I should put it up on our webpage.
The “denial” (note those “”) of the illness in anorexia is well described. It is one of the most frustrating aspects of the illness for carers and clinicians alike. It contributes greatly to the expressed emotion (frustration, anger, criticism and patient blaming) that comes from clinicians and acts as a therapist driven therapy interfering behaviour. Therapist will describe their feelings that somehow the patient is willfully lying to them, because the patient “must” be aware of their illness. They are being that naughty anorexic patient who seems to seek out to disrupt therapy. What if clinicians ask that question that we ask patients so often “Is there a different, more workable, way of thinking about this?” As always, the answer is yes. Until I began reading the blogs of Laura Collins, I had never heard of anosognisia. This is apparently a common problem in several brain diseases which where the sufferer no insight or is unaware of the illness. It occurs in neurological diseases such as Alzheimer’s disease, Huntington’s disease and after strokes. It can also be a feature of schizophrenia and bipolar disorder. Some FMRI pictures and more information can be found here. Im not sure if it has ever been studied in anorexia nervosa. Im not sure if it would be preexisting and exacerbated by starvation, or caused by starvation. It important though for us to hold information in a way that may help us see that anorexia nervosa is not a willful choice. Holding this stance is incredibly helpful for therapist (and hence their patients).  What just happened. I went to bed before the budget knowing that I could do my best to treat patients with eating disorders in line with the guidelines that we know to be scientifically valid. Under the original "Better Access" Scheme, patients could typically receive 18 sessions of treatment subsidised by Medicare. When I woke up after the budget this rebate had been cut to 10 sessions. Now the government had based this figure in part on data produced by my professional body the Australian Psychological Society. This data indicated that most patients were receiving about 6 - 8 sessions of therapy before the completion of their treatment. Only about one percent of therapists were using upto 18 sessions with their patients. I think that 1% may have been me. The other 99% must have not been seeing patients with eating disorders. Lets look a little at the treatment of people suffering from eating disorders and why we have a problem. The eating disorders are amongst the most serious psychiatric disorders. Eating Disorders effect up to 10% of Australian women. Anorexia Nervosa is the third most common chronic illness effecting adolescent women. It has the highest mortality rate of ANY psychiatric illness, with 20% of patients dying from the illness after a prolonged history. Matched for age, patients with anorexia nervosa have a death rate five times higher than the general population. Death from suicide is relatively common, being 32 times higher than expected than in the general population (for comparison, patients diagnosed with major depression are 20 times more likely to die from suicide). The Eating Disorders are often chronic and debilitating illness. On average, patients with Anorexia Nervosa have a similar level of disability to those suffering from Schizophrenia and Borderline Personality Disorder. In a systematic review of the literature eating disorders are shown to have one of the highest impacts on health related quality of life of all psychiatric disorders. Cost of treatment per year for Anorexia Nervosa is as expensive as that required for schizophrenia. Data from the private hospital system indicates patients with eating disorders are the most expensive patients to treat in a hospital setting. This is due to the complex psychiatric and physical comorbidity, the protracted length of treatment, and the requirement of specialist care. We know that patients who have access to the empirically supported evidence based approaches provided by specialist services have a significantly improved outcome. This is particularly so for those who are able to access these treatments early in the course of their illness. There are two well validated outpatient treatments for patients with the eating disorders, Family Based Therapy for Anorexia Nervosa, and Cognitive Behaviour Therapy for Bulimia Nervosa. The treatment of the eating disorders is complex and often protracted. The treatment manuals for both FBT and CBT indicate that the number of sessions recommended for treatment 20 treatment session over a 6 - 12 month period. This is of course the problem. We had 18 sessions, which almost fitted in with what works. Now we have 10 session. This is half the recommended course of treatment. (Actually, I'm not sure 18 was ever really enough but that is an argument for another time {I suspect now in the distant past}. I'm not going to mention the problems of FBT under the current legislation). The government’s recent reduction of this figure to 10 sessions is woefully inadequate for my patients needs. The reduction will result in fewer patients accessing appropriate treatment within an adequate time frame. Outcomes from the eating disorders will deteriorate and the personal, social and economic burden from the eating disorders will increase. So, what to do ...... I am a great advocate of accept what you can't change AND trying to change something that you can do something about. There was a move to remove Social Workers from the Medicare Scheme which was reversed die to public pressure. I am hopeful that the same can happen here. Lift what you want from what I have written above and send an email to the Minister for Health and Ageing Nicola Roxon and Minister for Mental Health Mark Butler Lets not forget the Greens (whom I've heard are supportive of my position) bob.brown@aph.gov.au and the independants senator.xenophon@aph.gov.au senator.fielding@aph.gov.au Peter.Dutton.MP@aph.gov.au Mark.Butler.MP@aph.gov.au Tony.Windsor.MP@aph.gov.au robert.oakeshott.mp@aph.gov.au Lets get active to support the effective and affordable treatment of eating disorders. I know I have. Chris Thornton Clinical Director The Redleaf Practice. | AuthorChris Thornton is a Clinical Psychologist and the Clinical Director of The Redleaf Practice, a specialist outpatient clinic for the treatment of eating disorders. He is interested in bringing elements of positive psychology, Cognitive Behavioural Therapy and Acceptance and Mindfulness approaches to the treatment of eating disorders. ArchivesFebruary 2013 CategoriesAll |
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